1414. Right Antibiotic for Right Bug: Impact of Criteria Based Indications on Reduction of Gram Positive Agent Use at a Large Multi-State Health System
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • Poster-IDSA-Grampos-15.pdf (193.1 kB)
  • Background:   Inappropriate antimicrobial use leads to resistance leaving limited options to treat patients. It is critical to promote stewardship by establishing clinical indications for use and monitoring compliance. We describe the impact of criteria based indications of daptomycin, linezolid, tigecycline and ceftaroline utilization in our 80 hospitals located in 22 States and District of Columbia.

    Methods:  An expert group comprised of physicians and clinical pharmacists from different facilities developed evidence based clinical utilization criteria of the four Gram-positive active agents. This was supported and approved by other system clinical committees. The indications were implemented in the beginning of fiscal year (FY) 2015. Hospital pharmacy leaderships were accountable for engaging with the physicians for implementation of the initiative. In addition, monthly updates on system and individual facility mean, maximum and minimum defined daily dose (DDD)/1000 patient days of each agent were provided to pharmacy leadership. This information was also reviewed at the monthly pharmacy leadership calls.

    Results:  The use of daptomycin, linezolid and tigecycline (DDD/1000 patient days) decreased by 14%, 43% and 24% compared to baseline in FY 2014 (Table). Ceftaroline use remained at the same level. Interestingly, vancomycin DDD/1000 patient days decreased from 106.2 to  87.2 (17.9% decrease).

    Conclusion: System-wide criteria based utilization of targeted agents resulted in significant reduction of targeted drug usage while preserving them for appropriate usage.The success was based on clear identification of criteria for use, ownership at local level, and monthly feedback of utilization to all hospitals involved. 

    Table

    Agent

    Mean  DDD/1000 Pt Days

    % Decrease

    Maximum

    DDD/Pt Days

    Minimum DDD/Pt Days

    2014*

    2015

     

    2014*

    2015

    2014*

    2015

    Daptomycin

    14.7

    12.7

    14%

    21.9

    25.3

    8.5

    9.8

    Linezolid

    5.8

    3.3

    43%

    8.7

    5.0

    3.3

    2.0

    Tigecycline

    1.7

    1.3

    24%

    2.9

    3.3

    0.9

    0.6

    Ceftaroline

    1.7

    1.5

    No change

    2.5

    2.1

    2.5

    2.1

    Vancomycin

    106.2

    87.5

    17.9%

    167.7

    119.8

    62.6

    68.4

    All 5 Agents

    130.1

    106.3

    18.3%

    203.7

    155.5

    77.8

    82.9

    *2014- Baseline

    Roy Guharoy, PharmD, MBA1,2, Mohamad G. Fakih, MD, MPH, FIDSA, FSHEA3,4, Karen Smethers, Pharm.D.5, Michelle Heavens, BSN, MHA4, Ann Hendrich, RN, PhD4 and Jeffrey Seggerman, MBA5, (1)Medicine, University of Massachusetts Medical School, Worcester, MA, (2)Care Excellence, Ascension Health, St. Louis, MO, (3)Infection Prevention and Control, St. John Hospital & Medical Center, Grosse Pointe Woods, MI, (4)Care Excellence, Ascension Health, St Louis, MO, (5)Ascension Health, St Louis, MO

    Disclosures:

    R. Guharoy, None

    M. G. Fakih, None

    K. Smethers, None

    M. Heavens, None

    A. Hendrich, None

    J. Seggerman, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.